Sedation Management in the Intubated Pediatric Patient as a Method to Reduce Neuromuscular Blockade Utilization Rate During Transport: A Quality Improvement Project

Objective

Models recommending continuous sedation combined with specific tools to assess sedation depth during pediatric transport do not exist. Published studies demonstrate that nurse-driven sedation protocols yield more consistent levels of appropriate sedation.

Methods

A retrospective review in 2020 of mechanically ventilated pediatric transport patients at this institution demonstrated that 60.7% received neuromuscular blockade. This higher than anticipated neuromuscular blockade usage indicated an opportunity to improve sedation management. The primary aim of this quality improvement project is to decrease neuromuscular blockade use to < 30% of intubated pediatric patients cared for by our critical care transport team. To achieve this, we aimed to improve patient sedation by increasing the use of continuous sedation medication infusions to > 75% of patients by the first quarter of 2022. The initiative took place with a hospital-based pediatric/neonatal critical care transport team.

Results

Continuous sedation infusions increased using protocolized sedation from 10.7% at baseline to a sustained rate of 88% with dexmedetomidine (76.3%) and propofol (13.6%) as primary medications. The percentage of patients receiving neuromuscular blockade decreased in stepwise fashion from the initial 60.7% to 8.3%.

Conclusion

This project demonstrated sustained improvement in continuous sedation and decrease in neuromuscular blockade use through the initiation of a continuous sedation protocol in transport.